The Effect of Two Different Anesthetic Methods on Gastrointestinal Motility in Patients Scheduled for Laparoscopic Sleeve Gastrectomy: A Prospective, Randomized, Single-blinded Clinical Trial.

PURPOSE: Hyperperistalsis during laparoscopic surgery may reduce surgical manuplation. The primary purpose of this study was to compare the effects of two anesthetic methods on gastrointestinal motility.

DESIGN

Prospective, randomized, single-blinded study

METHODS

This study was conducted with patients with a body mass index over 35 kg/m2 undergoing elective laparoscopic sleeve gastrectomy. Patients were allocated into two groups: Group Desflurane (D) was given desflurane and remifentanil infusion for anesthesia maintenance, and in Group (T), total intravenous anesthesia was performed with propofol and remifentanil infusions. Peristaltic waves were counted by the surgeon visually over 1 minute for assessment of gastrointestinal motility during anastomosis. Postoperative nausea and vomiting, antiemetic requirement, time of first flatulence, and surgeon's satisfaction were compared.

FINDINGS: Fifty-six patients were enrolled in the study. There was no significant difference in age, gender, weight, comorbidities, or body mass index between the groups. In Group D, a median of 1 (0 to 16) wave was registered over 1 minute, compared with 0 (0 to 11) in Group T (P = .014). Surgeon's satisfaction in Group T was statistically higher than that in Group D (P = .021). Time for anastomosis, surgical duration, and remifentanil dose at anastomosis were similar between the two groups. Nausea and antiemetic use significantly higher in Group T (P = .002). Time of first flatulence was similar in both groups.

CONCLUSIONS

Propofol and remifentanil combination is preferred for laparoscopic sleeve gastrectomy, where decreased intestinal peristaltism provides better surgical management and higher surgeon's satisfaction with decreased in postoperative nausea and vomiting.